Ob-Gyn Coding Alert

Tip: Use the dx that is directed at the fetus whose issue is currently being addressed.

If you’re confused about how to apply those 7th character to your fetus diagnosis codes, you’re not alone. Check out these oft asked questions and answers.

Discover When You Should Use 7^th Character ‘0’ or ‘9’

Question 1: If the patient is pregnant with one fetus, are we supposed to use O35.1XX0 or O35.1XX9?

Answer: Code O35.1- is the code for maternal care for (suspected) chromosomal abnormality in fetus, which means you need to pay attention to the final digit of the multiple gestation code.

So O35.1xx0 (Maternal care for (suspected) chromosomal abnormality in fetus, not applicable or unspecified) would mean this was a singleton pregnancy, while O35.1xx1 (Maternal care for (suspected) chromosomal abnormality in fetus, fetus 1) would mean fetus one had the issue. If you used O35.1xx9 (Maternal care for (suspected) chromosomal abnormality in fetus, other fetus), this would mean that a fetus other than 1, 2, 3, 4, or 5 had the complication (such as fetus 7 in septuplets), says Melanie Witt, RN, MA, an independent coding consultant from Guadalupita, New Mexico.

Focus on the Encounter to Identify Fetus Number

Question 2: Suppose your ob-gyn treats a patient with a twin pregnancy, with a spontaneous abortion of fetus 2. In this case, would you use O31.11x1 because fetus 1 is continuing the pregnancy? Or should we use fetus 2 because that was the demise?

Answer: Normally you will use the code that is directed at the fetus whose issue is currently being addressed.

If this visit is all about handling fetus 2, then the 7th character is 2. The code would be O31.11x2 (Continuing pregnancy after spontaneous abortion of one fetus or more, first trimester, fetus 2).

If that is now past and the fetus 1 is continuing, then the final character is 1 (O31.11x1, ... fetus 1).

If the ob-gyn is evaluating both fetuses (the physician might do an ultrasound to see the status of fetus 1), then use the code twice with a 7th digit of 1 (linked to that evaluation) and 2 (linked to that E/M [evaluation and management] service). The codes you would use might be 76815 (Ultrasound, pregnant uterus, real time with image documentation, limited [eg, fetal heart beat, placental location, fetal position and/or qualitative amniotic fluid volume], 1 or more fetuses) to check on fetus 1 and 99222 (Initial hospital care, per day, for the evaluation and management of a patient ...) for the medical management of the spontaneous abortion in the hospital.

Here’s How to Handle Fetus A, B Documentation

Question 3: Suppose your ob-gyn documents a patient’s twins as “fetus A” and “fetus B.” However, you know that the fetal extensions in chapter 15, Pregnancy, childbirth and the puerperium, for codes related to complications of multiple gestation (e.g., O31, O32, etc.) refer to fetus 1, fetus 2, and so on and so forth. What should you do?

Answer 3: According to the AHA ICD-10-CM Coding Clinic (2012 Vol. 29 No. 04), you should assume fetus A means fetus 1, and fetus B means fetus 2.

Remember, your ob-gyn may not consistently document the same fetus number or alphabetical character from one admission to the other. You have to go with whatever the provider documents.